Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Is Poor Sleep a Risk Factor for AF?

Heart Rhythm; ePub 2018 Jun 25; Christensen, et al

Sleep disruption consistently predicted atrial fibrillation (AF) before and after adjustment for obstructive sleep apnea (OSA) and other potential confounders across several different patient populations, a recent study found. Researchers performed an analysis of participants in the Health eHeart Study and validated findings in the longitudinal Cardiovascular Health study, including a subset of patient undergoing polysomnograpy. They then examined 2005-2009 data from the California Healthcare Cost and Utilization Project. They found:

  • Among 4,553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (OR, 1.47).
  • Frequent nighttime awakening predicted a 33% greater risk of AF (HR, 1.33) in 5,703 Cardiovascular Health Study participants followed for a median 11.6 years.
  • Among 1,127 patients with polysomnograpy, every standard deviation percentage decrease in rapid eye movement (REM) sleep was associated with an 18% higher risk of developing AF (HR, 1.18).
  • Among 14,330,651 California residents followed for a median 3.9 years, an insomnia diagnosis predicted a 36% increased risk of new AF (HR, 1.36).


Christensen MA, Dixit S, Dewland TA, et al. Sleep characteristics that predict atrial fibrillation. [Published online ahead of print June 25, 2018]. Heart Rhythm. doi:10.1016/j.hrthm.2018.05.008.